| NPI | 1164412904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NJ 77SC00483900) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW-006496-L) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2007-07-08 |